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Ovarian Pathology Flashcards

1
Q

What type of ovarian cyst is due to non rupture of the dominant follicle?

A

Follicular

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2
Q

What blood marker would raise your suspicion of ovarian cancer?

A

CA125

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3
Q

A 34 year old lady present to a&e with sudden onset abdominal pain that came on when she was running and has been getting increasingly worse over the last 2 hours. She describes the pain as sharp and stabbing. She says she has had some episodes of stabbing pain in the past but they have resolved after 30 mins, unlike this.

A

Ovarian cyst torsion

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4
Q

Describe how a follicular ovarian cyst arises

A

Forms when ovulation doesn’t occur
Follicle doesn’t rupture but grows until it becomes a cyst.
Thin walled and lined by granulosa cells

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5
Q

Describe what you should so if you find a pelvic mass on examination of a 54 year old women.

A
  1. Blood sample for tumour markers (CA 125)
  2. US scan
  3. Use age, menopausal status and US score to calculate risk of malignancy index
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6
Q

What three factors are taken into consideration when making a risk of malignancy index score?

A

CA125 value
Menopausal score
US score

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7
Q

How is the RMI in ovarian cancer calculated?

A

CA125 value x Menopausal score x US score

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8
Q

A score above what value on the RMI suggests high risk?

A

200

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9
Q

What is the name given to an ovarian metastatic tumour from gastric cancer?

A

Krukenberg tumour

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10
Q

On what chromosome is the mutation for the BRCA1 gene found?

A

17

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11
Q

On what chromosome is the mutation for the BRCA2 gene found?

A

13

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12
Q

What is the lifetime risk of someone with a BRCA 1 mutation developing ovarian cancer?

A

30 - 60%

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13
Q

What is the lifetime risk of someone with a BRCA 2 mutation developing ovarian cancer?

A

20%

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14
Q

What is the most common benign epithelial tumour of the ovary?

A

Serous cystadenoma

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15
Q

What are the three classifications of epithelial ovarian tumours?

A

Benign
Borderline
Malignant

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16
Q

On pathology of an ovarian cyst you see a simple cystic form with a smooth surface and smooth lining. there is no cytological abnormalities and no excess proliferation. Is this a benign, borderline or malignant epithelial tumour?

A

Benign

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17
Q

On pathology of an ovarian cyst you see cytological abnormalities and excess proliferation. There is no stromal invasion Is this a benign, borderline or malignant epithelial tumour?

A

Borderline

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18
Q

On pathology of an ovarian cyst you see cytological abnormalities, excess proliferation and stromal invasion Is this a benign, borderline or malignant epithelial tumour?

A

Malignant

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19
Q

Where does ovarian high grade serous cacrinoma usually originate?

A

Fallopian tubes

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20
Q

What is the precursor lesion for high grade serous cacrinoma?

A

Serous tubal carcinoma

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21
Q

What is the precursor for low grade serous carcinoma?

A

Serous borderline tumour

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22
Q

List the 5 types of epithelial ovarian tumours

A 
Serous
Mucinous
Endometrioid
Clear cell
Brenner
(undifferentiated)
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23
Q

What 2 conditions are associated with endometrioid and clear cell carcinoma of the ovary?

A

Endometriosis of the ovary

Lynch sydrome

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24
Q

What is a brenner tumour?

A

Ovarian tumour of transitional type epithelium. Usually benign

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25
Q

Tumour of transitional type epithelium?

A

Brenner tumour

26
Q

A tumour containing teeth, har and subum?

A

Germ cell tumour

27
Q

List three types of ovarian sex cord/stromal tumours

A

Fibroma
Granulosa cell tumour
Sertilo Leydig cell tumour

28
Q

What stage is ovarian cancer if it limited to one ovary only?

A

1A

29
Q

What stage is ovarian cancer if it is in both ovaries only?

A

1B

30
Q

What stage is ovarian cancer if it is in the ovarier and on the ovarian surface?

A

1C

31
Q

What stage is ovarian cancer if it has extended into the fallopian tube?

A

2A

32
Q

What stage is ovarian cancer if it has spread to other pelvic intraperitoneal organs?

A

2B

33
Q

What stage is ovarian cancer if there is reteroperitoneal lymph node spread?

A

3A

34
Q

What stage is ovarian cancer if there is microscopic extrapelvic peritoneal involvement?

A

3A

35
Q

What stage is ovarian cancer if there is macroscopic peritoneal metastasis up to 2cm in dimension?

A

3B

36
Q

What stage is ovarian cancer if there is macroscopic peritoneal metastasis over 2cm in dimension?

A

3C

37
Q

What stage is ovarian cancer if there is distant metastasis

A

4

38
Q

What kind of ovarian tumour caused defeminisation and then subsequent masculinisation with facial hair growth and clitoral enlargement

A

Sertoli leydig Cell tumour

39
Q

What are the two most common chemotheraputic agents used in the treatment of ovarian cancer?

A

Paclotaxil

Carboplatin

40
Q

What is the first lymph nodes that ovarian pathology will drain to?

A

Para aortic

Then pelvic and sometime inguinal

41
Q

Does lymphatic or haematogenous spread usually come first in ovarian cancer?

A

Lymphatic

42
Q

Above what stage and grade is chemotherapy recommened for?

A

Any ovarian cancer greater than Stage 1B grade 2

43
Q

How does carboplatin work as a chemotheraputic agent?

A

Alkylating agent that forms DNA cross links that prevent cell replication

44
Q

How does paclitaxel work as a chemotheraputic agent?

A

Prevents cell replication by interfering with cell microtubule formation

45
Q

What is the inheritence pattern of lynch syndrome?

A

Autosomal dominant

46
Q

What is the problem with the DNA in lynch syndrome? Why does it occur?

A

Defective DNA mismatch repair leading to microsatellite instability. Due to changes in the lengths of the dinucleotide repeats of cystonine and adenosine.

47
Q

What cancers are you at increased risk of if you have lynch syndrome?

A

Colorectal cancer
Endometrial carcinoma
Digestive adenoma: Gastric adenoma, pyloric gland adenoma, duodenal adenoma, intestinal adenoma
Ovarian serous cystadenocarcinoma

48
Q

What fertility treatment increases your risk of ovarian cancer?

A

Clomifine

49
Q

Which malignant ovarian tumour is most common?

A

Serous cystadenocarcinoma

50
Q

Which ovarian tumour causes a raised lactate dehydrogenase?

A

Dysgerminoma

51
Q

Which ovarian tumour is most associated with streak ovaries as seen in Turners syndrome?

A

Gonadoblastoma

52
Q

Which ovarian tumour produces AFP?

A

Yolk sac tumour

53
Q

Describe how a follicular cysts arises?

A

Ovulation doesn’t occur and the follicle doesn’t rupture but grows until it becomes a cyst

54
Q

How would you investigate a suspected follicular cyst?

A

US

55
Q

A 23 year old women presents with a very sharp pain in her left iliac fossa. She is in the middle of her menstrual cycle

A

Ruptured follicular cyst

56
Q

What are the two most commonly used chemotheraputic drugs in ovarian cancer?

A

Paclitaxel

Carboplatin

57
Q

What is Meigs Syndrome?

A

Ascited and pleural effusuion/hydrothorax is association with a benign, usuallu solid ovarian tumour. In 80 - 90% of cases the tumour is an ovarian fibroma

58
Q

What kind of ovarian tumour is most often associated with Meig’s syndrome?

A

Ovarian fibroma

59
Q

In which ovarian tumour would you most likely see a raised CEA?

A

Mucinous tumour

60
Q

What is the main function of doing a blood test for CEA in someone with an ovarian tumour?

A

If it is raised it suggests that the tumour is a metastasis from a primary GI tumour

61
Q

What is meant by optimal cytoreduction in debulking surgery?

A

No visible disease if left behind following laporotomy

62
Q

What lymph nodes are removed in the debulking surgery done in early stage ovarian cancer?

A

Pelvic

Para aortic

Reproduction (40 decks)

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